Ambient air pollution and posttransplant outcomes among kidney transplant recipients

Fine particulate matter (PM2.5), a common form of air pollution which can induce systemic inflammatory response, is a risk factor for adverse health outcomes. Kidney transplant (KT) recipients are likely vulnerable to PM2.5 due to comorbidity and chronic immunosuppression. We sought to quantify the association between PM2.5 and post‐KT outcomes. For adult KT recipients (1/1/2010–12/31/2016) in the Scientific Registry of Transplant Recipients, we estimated annual zip‐code level PM2.5 concentrations at the time of KT using NASA's SEDAC Global PM2.5 Grids. We determined the associations between PM2.5 and delayed graft function (DGF) and 1‐year acute rejection using logistic regression and death‐censored graft failure (DCGF) and mortality using Cox proportional hazard models. All models were adjusted for sociodemographics, recipient, transplant, and ZIP code level confounders. Among 87 233 KT recipients, PM2.5 was associated with increased odds of DGF (OR = 1.59; 95% CI: 1.48–1.71) and 1‐year acute rejection (OR = 1.31; 95% CI: 1.17–1.46) and increased risk of all‐cause mortality (HR = 1.15; 95% CI: 1.07–1.23) but not DCGF (HR = 1.05; 95% CI: 0.97–1.51). In conclusion, PM2.5 was associated with higher odds of DGF and 1‐year acute rejection and elevated risk of mortality among KT recipients. Our study highlights the importance of considering environmental exposure as risk factors for post‐KT outcomes. Among kidney transplant recipients, higher ZIP code–level fine particulate matter is associated with increased odds of delayed graft function and 1‐year acute rejection and increased risk for all‐cause mortality. Ross‐Driscoll et al.'s editorial is on page 3219.